Persons United Limiting Substandards and Errors in Health Care

Declaration as to medical treatment: 15-18-104.

(1) Any competent adult may execute a declaration directing that life-sustaining procedures be withheld or withdrawn if, at some future time, he is in a terminal condition and either unconscious or otherwise incompetent to decide whether any medical procedure or intervention should be accepted or rejected. It shall be the responsibility of the declarant or someone acting for him to submit the declaration to the attending physician for entry in the declarant's medical record.

(2) In the case of a declaration of a qualified patient known to the attending physician to be pregnant, a medical evaluation shall be made as to whether the fetus is viable and could with a reasonable degree of medical certainty develop to live birth with continued application of life-sustaining procedures. If such is the case, the declaration shall be given no force or effect. (2.5) (a) The declarant may provide in his declaration that, in the event that the only procedure being provided is artificial nourishment, one of the following actions shall be taken: (I) That artificial nourishment not be continued when it is the only procedure being provided; or (II) That artificial nourishment be continued for a specified period of time when it is the only procedure being provided; or (III) That artificial nourishment be continued when it is the only procedure being provided. (b) A declaration executed prior to March 29, 1989, may be amended by a codicil to include the provisions of this subsection (2.5). (2.6) Notwithstanding the provisions of subsection (2.5) of this section and section 15-18-103 (7), when an attending physician has determined that pain results from a discontinuance of artificial nourishment, he may order that such nourishment be provided but only to the extent necessary to provide comfort and alleviate such pain.

(3) A declaration executed before two witnesses by any competent adult shall be legally effective for the purposes of this article and may, but need not, be in the following form:

DECLARATION AS TO MEDICAL OR SURGICAL TREATMENT:
I, (name of declarant) , being of sound mind and at least eighteen years of age, direct that my life shall not be artificially prolonged under the circumstances set forth below and hereby declare that: 1. If at any time my attending physician and one other qualified physician certify in writing that: a. I have an injury, disease, or illness which is not curable or reversible and which, in their judgment, is a terminal condition, and b. For a period of seven consecutive days or more, I have been unconscious, comatose, or otherwise incompetent so as to be unable to make or communicate responsible decisions concerning my person, then I direct that, in accordance with Colorado law, life-sustaining procedures shall be withdrawn and withheld pursuant to the terms of this declaration, it being understood that life-sustaining procedures shall not include any medical procedure or intervention for nourishment considered necessary by the attending physician to provide comfort or alleviate pain. However, I may specifically direct, in accordance with Colorado law, that artificial nourishment be withdrawn or withheld pursuant to the terms of this declaration. 2. In the event that the only procedure I am being provided is artificial nourishment, I direct that one of the following actions be taken: (initials of declarant) a. Artificial nourishment shall not be continued when it is the only procedure being provided; or (initials of declarant) b. Artificial nourishment shall be continued for days when it is the only procedure being provided; or (initials of declarant) c. Artificial nourishment shall be continued when it is the only procedure being provided. 3.
I execute this declaration, as my free and voluntary act, this day of , 19 . By ________________________
Declarant The foregoing instrument was signed and declared by to be his declaration, in the presence of us, who, in his presence, in the presence of each other, and at his request, have signed our names below as witnesses, and we declare that, at the time of the execution of this instrument, the declarant, according to our best knowledge and belief, was of sound mind and under no constraint or undue influence.
Dated at , Colorado, this day of , 19 . _____________________________________
Name and Address_____________________________________
Name and Address STATE OFCOLORADO ) ) ss. County of ____________________) SUBSCRIBED and sworn to before me by , the declarant, and and , witnesses, as the voluntary act and deed of the declarant this day of , 19 .
My commission expires: ___________________________ Notary Public--Inability of declarant to sign: 15-18-105.

(1) In the event that the declarant is physically unable to sign the declaration, it may be signed by some other person in the declarant's presence and at his direction. Such other person shall not be: (a) The attending physician or any other physician; or (b) An employee of the attending physician or health care facility in which the declarant is a patient; or (c) A person who has a claim against any portion of the estate of the declarant at his death at the time the declaration is signed; or (d) A person who knows or believes that he is entitled to any portion of the estate of the declarant upon his death either as a beneficiary of a will in existence at the time the declaration is signed or as an heir at law.

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